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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o° o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> ?IS-- ;790-7 3& 5 y <br /> IGG- ky3y Unr� / G•/G-o g <br /> OWNER t)Py/U 1Uln4S-F&,- TELEPHONE (o56-�vSo �fTG2 6-11P-o o <br /> f <br /> MAILINGADDRESS ( R <br /> 2 30s-�y T ov Lemur rive �� 6�v �5��31� v1 <br /> 0- G, <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) 4-0- 12 l-J/I l V17 ?zs3 m <br /> 2 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE M ADDITION ❑ to 0 <br /> TYPE OF PERMIT(S): c ' <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> STRUCTURE/ADDITION USE: CGnere7r rinov )A P.I mtjnG o?</X c 7/ 66k.,e ZL/2 (O &241. o <br /> ((.Home/Cabin Comm tial Bus'ness; Bedroom; Deck; etc.) n <br /> /glJo 2j+/XaDce c'kre 9nb4. Efide �/�4��iye yX3S/J�dew,k n <br /> BUILDING CONTRACTOR: GI.Si(/[ m C/' <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8Y X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 e <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. n <br /> T1 N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O cQi- <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m S NORTH(N). y N I 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m W 9 <br /> CENTERLINE OF ROAD,(C)BUILDING(S) MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. I o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO <br /> BUILDINGS, ROADS, LAKE,LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. ly Jin <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS 0 `�.l <br /> MUST BE SIGNED AND DATED BY THE OWNER. o r )n <br /> o vl <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN � <br /> NEEDED. (' <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> 0 <br /> CONDITIONS OF PERMIT: �P <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 9 ff \..,, <br /> ISSUANCE. V <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> T7 W Or D0 DO n7 <br /> m c m d o m a f m <br /> 6. x3 nm `sad. -a <br /> Z c y o <br /> 05 <br /> 7. o <br /> O ? i m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my O <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of C <br /> all information contained in this application (Including any accompanying schedule)and I further declare that I recognize I m c o <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- rn <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information I am W I o I <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person have access to the ab o a described premises at any reasonable time for the purpose of inspection. <br /> T <br /> � a <br /> SIGN HERE <br /> (si nature of own r or bui <br /> nlding contractor) (date) 0 <br /> ZONINGA MINISTRATOR ` '001 1 nrcD <br /> ' <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM <br /> , D TE OF ISSUANC1- , <br /> 4 W r <br /> t-- dl1' LO � - f � ) d� <br />